PREVENT is the heart risk calculator from the American Heart Association. You enter a few routine numbers, and it estimates your chance of a heart attack, stroke or heart failure over the next 10 years and the next 30 years.
Your percentage is an estimate for people with numbers like yours. It is not a prediction about you personally. Other tests can refine it.
Key takeaways
- PREVENT uses routine numbers to estimate your 10-year and 30-year chance of heart attack, stroke or heart failure.
- The result describes people with numbers like yours and is not a personal prediction.
- It usually gives lower numbers than the old calculator, so the risk bands were reset and intermediate risk now starts at 5%.
- It leaves out family history, Lp(a), ApoB, inflammation and imaging.
- Borderline or intermediate results can be refined with risk enhancers and sometimes a calcium score, which is not a test for everyone.
What PREVENT is and why it replaced the old calculator
For about a decade, US clinicians used a tool called the Pooled Cohort Equations. It was built on older data and gave separate results by race. The 2026 ACC/AHA cholesterol guideline replaced the older Pooled Cohort Equations with PREVENT and set new 10-year risk bands to go with it.1
PREVENT stands for Predicting Risk of cardiovascular disease EVENTs. The equations were built from the records of more than 3 million US adults and then checked in another 3.3 million.2 Three things set it apart:
- It does not use race. The equations are specific to sex but not to race.
- It includes kidney function. Kidney health and heart health are closely tied.
- It covers more than heart attack and stroke. PREVENT estimates 10-year and 30-year risk of total cardiovascular disease, meaning atherosclerotic disease plus heart failure, for adults aged 30 to 79.3
What goes into the calculation
The basic version uses information most people already have from a routine visit:
- Age and sex
- Total cholesterol and HDL cholesterol
- Systolic blood pressure, the top number
- Whether you take blood pressure medication or a statin
- Whether you have diabetes
- Whether you smoke
- Kidney function, reported on lab results as eGFR
- Body mass index (used only for the heart failure estimate, not for heart attack and stroke risk)
Three optional inputs can be added when they are available: hemoglobin A1c, a urine test for kidney damage called the albumin-to-creatinine ratio, and a neighborhood measure called the social deprivation index, which is looked up from your zip code. In the validation studies these extras improved accuracy only slightly for most people. The urine test mattered most for people with significant protein in the urine.
What your percentage means
A 10-year risk of 6% means that out of 100 people with your numbers, about 6 would be expected to have a cardiovascular event in the next 10 years, and about 94 would not. The current guideline sorts 10-year risk into four bands.
| 10-year risk | Band | What it usually means |
|---|---|---|
| Under 3% | Low | Healthy habits are the main focus. |
| 3% to under 5% | Borderline | Risk enhancers can shift the picture. |
| 5% to under 10% | Intermediate | Extra information often helps the treatment discussion. |
| 10% or higher | High | A treatment discussion with your clinician is warranted. |
The 30-year number is most useful if you are younger. At 40, your 10-year risk can be low simply because of your age, while your 30-year risk shows where your current numbers are heading. Our article on heart disease risk in your 40s, 50s and 60s explains why the earlier decades matter.
Why your number may be lower than before
If you had your risk calculated a few years ago and it has now dropped, you may not have changed. The calculator did.
PREVENT gives lower estimates than the old equations for most people. When researchers applied PREVENT to a national sample of US adults, about half moved into a lower risk category than the old equations gave them, and almost none moved higher.4
This is why the risk bands were reset. Under the old tool, intermediate risk began at 7.5%. With PREVENT it begins at 5%. A PREVENT result of 6% is not a low number, even though it would have looked low on the old scale.
What PREVENT does not include
A calculator can only work with what you give it. PREVENT does not take in several things that matter:
- Family history. A parent or sibling with early heart disease is not an input. See family history of early heart disease.
- Lp(a). This inherited particle is not included, although the 2026 guideline advises measuring it once in all adults.
- ApoB and inflammation. The calculator uses standard cholesterol values, not particle counts or hs-CRP.
- Imaging. It does not know whether you have plaque. A coronary calcium score is not an input.
- How long you have had a risk factor. Twenty years of high blood pressure and two years look the same.
It also does not apply if you already have heart disease, and it is designed only for ages 30 to 79.
How a borderline or intermediate result gets refined
If your result is clearly low or clearly high, the next step is usually straightforward. The middle bands are where extra information helps most.
Risk enhancers. These are factors that push real risk above the calculated number. The 2018 cholesterol guideline lists risk enhancers that include a family history of early heart disease, ApoB of 130 mg/dL or higher, Lp(a) of 50 mg/dL (125 nmol/L) or higher, and hs-CRP of 2.0 mg/L or higher.5 Chronic kidney disease, inflammatory conditions and menopause before age 40 are on the list too.
A coronary calcium score. When the decision is still uncertain, a calcium scan can show whether calcified plaque is present. Under the 2026 guideline, a score of zero supports holding off on medication and rescanning in three to seven years, unless you have diabetes, smoke, have familial hypercholesterolemia or have a strong family history. A higher score points the other way.
It is fair to add that the US Preventive Services Task Force found the evidence insufficient to say whether adding a calcium score or hs-CRP to standard risk assessment improves outcomes in adults without symptoms.6 These tools are for refining a decision that is unclear, not for everyone.
Your next step: fill in what the calculator leaves out
If your PREVENT result sits in the borderline or intermediate band, two guides are worth reading next: the coronary calcium score and the Lp(a) test. Both cover information PREVENT cannot see.
You can also answer the three quick questions in the Cardio Res-Q screener on our program page to see whether a closer evaluation makes sense for you.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
Is PREVENT more accurate than the old calculator?
It was built on much larger and more recent data, and its estimates track more closely with what is seen in the US population today. It is still an estimate for a group of people like you, so it can be too high or too low for any one person.
My risk came back low. Am I in the clear?
A low result is good news, but it has limits. PREVENT does not include family history, Lp(a) or imaging, and a low 10-year number in your 40s can sit alongside a much higher 30-year number. If early heart disease runs in your family, tell your clinician even if your percentage is low.
Why does the calculator ask about my kidneys?
Reduced kidney function is linked with higher cardiovascular risk, and it is measured on routine blood work. PREVENT uses the eGFR value from your lab report, and can also use a urine albumin test if you have had one.
Can I use PREVENT if I am under 30 or over 79?
No. The equations were developed and tested in adults aged 30 to 79 without known cardiovascular disease. Outside that range, risk is assessed by your clinician in other ways.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
